SAT-519 Frances Nicole Monefeldt Strofer

Abstract Disclosure: F.N. Monefeldt Strofer: None. Background: Tirzepatide, a new agent for type 2 diabetes (T2DM), enhances blood glucose levels by activating glucagon-like peptide-1 receptors (GLP-1R) through the incretin pathway. While effective in treatment, it's vital to acknowledge that a rare but serious side effect is pancreatitis, associated with incretin mimetics. Clinical Case: A 38-year-old obese female with a longstanding history of T2DM diagnosed at age 21, hypothyroidism and hyperlipidemia. She has experienced multiple episodes of pancreatitis over the years, attributed to severe hypertriglyceridemia. Her last episode in March 2022 led to hospitalization, during which diagnostic imaging confirmed an edematous pancreas without gallstones or biliary disease, and her lipid profile showed extremely elevated triglycerides. Post-hospitalization, the patient struggled with diabetes management due to side effects from conventional treatments, including gastrointestinal issues with metformin and recurrent yeast infections from SGLT2 inhibitors. Her treatment regimen prior to our evaluation included high-dose U-500 insulin, which was poorly controlled and contributed to further lipid abnormalities. Given her complex medical history and the significant impact of hypertriglyceridemia on her pancreatitis, we initiated treatment with tirzepatide 2.5 mg weekly after a detailed discussion of potential risks and benefits. Tirzepatide was selected for its dual action on glucose control and lipid metabolism, critical for patients like her with lipid-driven pancreatitis. Within three months of tirzepatide therapy, there was a marked improvement in her glucose control and lipid levels. Her A1C reduced from 8.35% to 6.3%, and her triglycerides decreased from 1,920 mg/dL to 749 mg/dL. Additionally, she reported significant weight loss of 10 pounds, enhancing her overall metabolic profile and reducing her daily insulin requirement by 90%. Discussion: This case demonstrates tirzepatide's effectiveness in managing T2DM in patients with hypertriglyceridemia-induced recurrent pancreatitis. Notable improvements in glycemic control, lipid levels, and weight reduction, coupled with a decreased need for insulin, highlight tirzepatide’s comprehensive impact on metabolic syndrome. Despite potential risks of pancreatitis with GLP-1RAs, our patient showed no exacerbation, indicating that tirzepatide can be used safely with careful monitoring. This case underscores the importance of tailored treatment strategies and further research into GLP-1RA safety and effectiveness in complex metabolic disorders, emphasizing holistic metabolic management in diabetes care. Presentation: Saturday, July 12, 2025